Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Angiology and Vascular Surgery Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
Ann Vasc Surg. 2021 Aug;75:179-188. doi: 10.1016/j.avsg.2021.01.082. Epub 2021 Feb 5.
Recent guidelines raise the concept of the importance of health-related quality of life (QoL). Change in QoL after amputation in ischemic patients is not well described. We aim to evaluate the change in quality of life after major limb amputation in patients with peripheral arterial disease.
We retrospectively identified all patients submitted to above-knee amputation (AKA) and below-knee amputation in our vascular surgery department in a 2-year period. Trauma excluded. A vascular amputee adapted QoL questionnaire was administered comparing the last 2 weeks to the 2 weeks before amputation. It included subjective and objective questions adapted from WHOQoL-BREEF and SF-36 divided into specific domains of QoL (physical health, role physical, pain, social, and psychological health) that were compared to 2 global items (overall QoL and general health). Independent samples tests and linear correlations were calculated.
A total of 106 patients were included, 30-day mortality rate 16.3% and 1-year 39.1%. Patients had an increase in mean total score after amputation of 14.35 out of 100 points, with an improvement of 52.1 points in pain and 11 points in social and psychological health out of 100 (P<0.001). Physical health and role physical scores decreased after amputation. Overall QoL was correlated with total score (P<0.001). Mean QoL total score after amputation was 79.0% ± 12.6. In general, amputees scored higher in the domains social and psychological health. Older people, women, AKA and bilateral amputees had lower physical health scores (P<0.05), prosthesis was correlated with improvement in physical health after amputation (P = 0.026). Elderly and married people had big improvement in overall QoL after amputation (P = 0.008 and P = 0.056, respectively).
QoL does not seem to diminish in advanced ischemic patients after amputation. Older people value more a decrease in pain and family support over physical health. Therefore, patient oriented treatments should be preferred. Future research should be made to validate a disease-specific questionnaire for this population.
最近的指南提出了健康相关生活质量（QoL）重要性的概念。缺血性患者截肢后 QoL 的变化尚不清楚。我们旨在评估外周动脉疾病患者大肢体截肢后生活质量的变化。
我们回顾性地确定了我们血管外科部门在 2 年内接受膝上截肢（AKA）和膝下截肢的所有患者。排除外伤。我们使用一种血管截肢者适应的 QoL 问卷，将截肢前最后 2 周与截肢前 2 周进行比较。它包括来自 WHOQoL-BREEF 和 SF-36 的主观和客观问题，分为生活质量的特定领域（身体健康、身体角色、疼痛、社会和心理健康），并与 2 个整体项目（整体 QoL 和一般健康）进行比较。计算了独立样本检验和线性相关性。
共纳入 106 例患者，30 天死亡率为 16.3%，1 年死亡率为 39.1%。截肢后患者的平均总分增加了 14.35 分，疼痛改善了 52.1 分，社会和心理健康改善了 11 分（均 P<0.001）。截肢后身体和身体角色评分下降。总体 QoL 与总分相关（P<0.001）。截肢后平均 QoL 总分 79.0%±12.6。总体而言，截肢者在社会和心理健康领域的得分较高。老年人、女性、AKA 和双侧截肢者的身体健康评分较低（P<0.05），假肢与截肢后身体健康的改善相关（P=0.026）。老年人和已婚人士在截肢后整体 QoL 有较大改善（P=0.008 和 P=0.056）。
在接受截肢的晚期缺血性患者中，QoL 似乎并没有下降。老年人更看重疼痛减轻和家庭支持，而不是身体健康。因此，应该优先采用以患者为中心的治疗方法。应进行进一步的研究，以验证针对这一人群的特定疾病问卷。
